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General NPI Number Information
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NPI Number | 1376844456
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Entity Type | Organization
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Legal Business Name | MARK A. BISHARA, MD, PA
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 550 N WALNUT CREEK DR SUITE 120
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City | MANSFIELD
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State | TX
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Zip | 76063-3223
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Country | US
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Telephone | 817-477-9000
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Fax | 817-887-5924
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Provider Business Mailing Address
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Address Line | 550 N WALNUT CREEK DR SUITE 120
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City | MANSFIELD
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State | TX
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Zip | 76063-3223
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Country | US
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Telephone | 817-477-9000
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Fax | 817-887-5924
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK A BISHARA
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Credential | M.D., P.A.
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Telephone | 817-477-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 236064
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License Number State | TX
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